He came from poverty and wasn’t expected to go much further than the small village in Co. Limerick where he was raised, but Michael Dowling, president and CEO of Northwell Health, never stopped dreaming and never stopped believing. His life story is proof positive that with hard work and determination, dreams can come true.

IF Michael Dowling wasn’t the president and CEO of Northwell Health, the 14th largest health care system in the United States with a value of $11 billion, he would have been a carpenter. Or a plumber. Or maybe he would have run a steel mill.

Those are just some of the skills the Knockaderry, Co. Limerick native mastered as a young, cash-starved immigrant to New York back in the early 1970s. He worked morning, noon and night, seven days a week, determined to climb the ladder of success as high as he possibly could.

Dowling’s relentless work ethic has catapulted him to great heights in America, but he’ll never allow himself to forget the Irish village where he was raised, or the values that he learned there.

A replica of the small Irish cottage where he grew up, hand built by Dowling 30 years ago and displayed in his Long Island home, is a reminder of the journey he’s taken through life. The thatched-roof cottage, sized like a dollhouse, provides a detailed view of the three-room home where he and his four siblings were raised in Knockaderry. He used the bristles of a broom for the thatch, and each miniature piece inside – a couple of beds and dressers covered with blankets, a table and chairs, a fireplace with bellows on the side – was also constructed by Dowling, who jokes that his handiwork “actually looks better than the house we grew up in.”

Michael Dowling with the replica of his childhood home that he constructed.  (Photo:Nuala Purcell.)

Michael Dowling with the replica of his childhood home that he constructed. (Photo:Nuala Purcell.)

The first thought upon seeing the craftsmanship of the cottage is that Dowling’s wife Kathleen is fortunate to have a built-in handyman at the Long Island homes where they raised two children. Dowling laughs and says that he’s still well able to tackle any renovations or repairs, though the time to do so is sparse given the consuming nature of his job.

“I learned to do everything, and it never bothered me. I was quick to pick up on things,” Dowling, 67, recalls of his early days in New York.

He built the cottage as a reminder of exactly where he came from. Heritage and history are greatly valued by Dowling, who makes a point of reading two to three books a month and recommending them to Northwell staff.

“If you don’t know where you came from you will never know where you are going. That’s something I have believed all my life, and I make a point of always telling people that,” he says.

Dowling’s journey has been nothing short of remarkable. He wasn’t expected to go much farther than Limerick, perhaps a safe, pensionable job on the local council which would have pleased his father to no end.

But Dowling had other plans and ambitions and went the way of the Irish who traveled across the Atlantic before him, in pursuit of his own version of the American Dream. And here he is today, the widely praised leader of a multi-billion dollar business, a sought-after expert in health care innovation, and a forever proud Irishman who will lead the highest profile parade in the world on March 17, 2017: the annual St. Patrick’s Day march up Fifth Avenue in New York City.

What would Dowling’s parents say to that?

“They would be proud,” Dowling says. “Very proud. And they’d tell me to make sure that I didn’t trip on Fifth Avenue while I was marching!”

BOOKS are a central component of Michael Dowling’s office at Northwell’s corporate headquarters in New Hyde Park, Long Island. The variety is vast, with selections focused on health care, American and Irish history, politics and government.

He has read every one of them. His beloved mother would have been upset if he hadn’t.

Meg Dowling didn’t have much formal education and became deaf at the age of six, like many others in the East Limerick village where she grew up. The belief is that the medicine they were given to treat symptoms of a cold had a side effect of deafness if used incorrectly. Meg never let her lack of hearing affect her life, and relied on reading lips and vibration to communicate.

An old family photo of Dowling and his mother.

An old family photo of Dowling and his mother.

“It was amazing,” Dowling recalled. “She could be sitting here with you and you could scream at the top of your lungs and she wouldn’t hear a thing. But you could always get her attention if something vibrated. She became very sensitive to it. Even if a quiet car drove by, she would still feel the vibration.”

Meg developed a passion for reading anything she could get her hands on. And though her school years were few, she was determined to always make books available to the five children she had with her husband Jack, a Limerick native who came from the other side of the county, a tiny place called Knockaderry.

“My mother was very, very focused on education,” says Dowling, the eldest child who was born in a house in November of 1949 with the aide of a midwife. “She was very well read, very bright, and never once thought that being deaf meant she had a disability. She would never consider herself disabled in any way.”

Jack Dowling was a laborer who worked for the county council and bicycled miles to work each day. He too didn’t have much in the way of proper schooling, and placed more importance on physical labor over book smarts.

“He was a tough, tough guy but he got arthritis at a young age, 42 or so, and after that he couldn’t work anymore. That was very tough for him because he loved to work,” says Dowling, who remembers his father coming in to the house on rainy days drenched from head to toe, standing in front of the open fire to get warm and dry, wet clothes still on and steaming from the heat of the flame.

Arthritis was a common affliction at the time, and not much could be done for Jack Dowling. He walked, sometimes, with a cane, while other times severe swelling all over his body rendered him bedridden. A local doctor was a few miles away, but there wasn’t much he could prescribe.

Housing seven people, the Dowling home had a mud floor and walls that regularly leaked, no running water, no electricity, no plumbing and no amenities at all, not even an outhouse. The center of the home contained the hearth where meals were prepared and the family gathered; the five children shared one of the other two rooms, and squeezed into a single bed or slept on the floor.

“It was small. You basically lived around the fire because when you moved away from it you froze,” Dowling recalls.

No one took notice of the absence of a bathroom. “Not at all,” he says. “We had two options – you went in a chamber pot inside, or else outside in the field. My wife couldn’t believe it. She says, ‘This could never have happened. You had to have privacy.’”

Dowling laughs at the conversation. “What privacy! Nobody bothered about it, you just went and that was that!”

Water was fetched from a well up the hill, and turf for the fire was cut from a bog miles away. Dowling would get there with a donkey and cart, cut the turf, dry it and bring it home.

Needless to say money was tight. The Dowlings were one of the poorer families in the village that was populated by many farmers.

“I used to think that they were all wealthy, but looking back over the years I realized they weren’t that wealthy. I thought their houses were beautiful then. We had a little piece of land ourselves where my father would grow vegetables. We had no animals or anything. I used to milk cows for the other farmers,” says Dowling.

He was a good milker too, and there was continuous competition to see who could milk the most cows in an hour. (Dowling was able to do nine). And he delights in retelling stories – in a brogue as thick as the day he left Ireland – about helping sows deliver piglets in his grandmother’s house nearby.

“The sow could be huge, so my grandmother would bring her into the kitchen to give birth. The animals were the livelihoods of the people, so they wanted to protect them and take good care of them,” he remembers.

“A sow can lean over after giving birth to 20 young ones and kill them. So we’d have to mind that. Or let’s assume a sow had 20 nipples and had 22 young ones, there was a good chance the extra two would die, so you had to feed those ones with a baby bottle. I remember doing that.”

Pigs would be killed and hung on a rafter, bathed in salt over the open fire to cure them with the smoke. Dowling’s mother would stand on top of a chair and slice the pig. His father was partial to pig’s tongue and all the fat.

Meg Dowling earned a little money on the side with her Singer sewing machine making clothes and dresses. She made outfits for her family too, and hand-me downs were always welcome in the household.

Michael helped the farmers around the village with various chores, though his father didn’t want him to accept money. That’s not the way locals worked with each other in those days. Sometimes favors held more worth than currency.

“The attitude was that you should do a favor for a farmer and take no money, so then when you needed something the farmer would help you. My father would say, ‘You can’t take money from these people. Maybe next week I might need their horse.’ Ireland back then was kind of a class system,” said Dowling.

Times were tough, but the Dowlings didn’t notice. They knew no different.

“Hard is all relative,” he says. “Nothing is hard if you don’t know what’s not hard. If you live in the environment I grew up in, it was just the way it was.”

Gaelic sports were huge in Knockaderry, and Dowling was a standout in hurling.

Dowling was a standout hurler.

Dowling was a standout hurler.

Everyone in the village was athletic – they walked or biked everywhere – and to get on the parish hurling team was a huge deal. Dowling did so with ease and became something of a local legend, winning medals with Knockaderry and graduating to the Limerick County team with which he won a National League medal in 1971. (The same team went on to capture the All-Ireland hurling final two years later, when Dowling was in New York.)

“You were just constantly outside in those days, playing, training, running around,” says Dowling. “When you were young you did a lot of physical labor and back then you were expected to do these things. There was no such thing as, ‘Oh, he’s too young, that’s too tough.’ No way.”

Reading and studying also consumed much of Dowling’s time. His mother brought books into the home from authors as diverse as Shakespeare and the American novelist Zane Grey, famous for his adventure series set in the western part of the United States. Dowling owns all of Grey’s works and to this day cites him as a major influence on his life.

“When I give talks I always remember him because he was able to write so you could visually see what he was talking about. He was a wonderful talent,” he says.

“I thought I knew the western part of the United States so well from his books. He would describe the scenery and the horizon, and you could just imagine it.”

A move to America wasn’t an aspiration of Dowling’s back then, but bettering himself through education definitely was. He often tells a story of a nearby farmer named Sullivan who had sons, one of whom was Michael’s age. The Dowlings used to get milk from him, and one day Sullivan said something that lit a fire in young Michael.

“I don’t think he meant it in a negative way, but to me it was an unbelievably motivating comment,” Dowling remembers. “He said, ‘Isn’t it too bad that somebody like you can never go to college.’ I came from the lower echelon and he was up here, and that was kind of the way it was.

“I remember coming home that night and every step of the way through the field I said to myself, ‘I’m going to college. I’m going to college.’”

College cost money, though, and the family was constantly in need too. Just before his 16th birthday Dowling went to London to work for the summer in a steel factory that made parts for trains. Sometimes he worked so hard that he slept on the factory floor. But he made money for his family with some to spare for his hoped-for higher education.

Dowling spent two summers in England. He was there when he got the results of his leaving cert exams, the equivalent of high school. He worked hard and thought he would do well enough to move on to college but he wasn’t totally certain. The lingering doubt about his abilities persisted even though he relished learning, always did well on exams and considered studying to be “unbelievably joyful.”

“But I thought I could never be as smart as the guy with a lot of money,” Dowling said. “I remember getting the results, slowly opening the envelope, and seeing that I had made it.”

Dowling enrolled at University College Cork (UCC). He had made money to pay for some but not all of his first year of tuition, so to compensate he would return home to Knockaderry on weekends and holidays to work at a local construction company. The mode of transport was hitchhiking.

“I first went to college on a milk truck,” he laughs. “I would hike home most weekends. And it was never really a problem.”

What to focus his studies on was easy, or so Dowling thought. Didn’t everybody go to college to become a teacher? He eventually found out that the course selection was vast and that limiting his career choice wasn’t necessary.

“I realized that I could become a lawyer, or work in agricultural science, or anything really,” Dowling says. “I had no clue because I had nothing to go by. I signed up for liberal arts and had no idea what it was.”

That didn’t stop him from earning top grades. But he still didn’t think he was as smart as his peers, nor did he have the most fashionable clothes. During his first year he had to wear a cap and gown to class. “That was a requirement -- a big black flowing gown,” Dowling recalls. “You couldn’t register if you didn’t have the cap and gown. And then you had to wear it to class, but eventually that was eliminated.”

His hurling skills proved quite useful. Dowling easily made the UCC squad and was a star player. He became involved in college politics as vice president of the Student Council.

Dowling had heard that work was abundant in America, the place he had always read about but had no connections to. He decided to see for himself what it was like at the end of his first year in college, so off he went to New York City in the summer of 1968.

He got a job on the West Side docks where he worked all the hours available and saved money for his family and his tuition. New York, he was discovering, was everything it was cracked up to be. Work hard and you’ll get what you want, which in Dowling’s case was money.

“It was exciting,” Dowling recalls of those days. “The first night I arrived I stayed in a hotel across from Madison Square Garden just for the one night. I couldn’t believe the height of the buildings. It was like, wow, I’m in New York, a place you never thought you’d get to, and all of a sudden you’re right in the middle of it.”

It took a while for Dowling to work through the country bumpkin side of himself. Sometimes new food choices were strange – “pigs in the blanket? I had no idea,” he laughs – and drinking American-style tea was also an oddity.

Dowling remembers going to one of the old automats, Horn & Hardart’s on Third Avenue, and ordering a cup of tea. The water was nice and hot, but the bag and string with it was strange. He hadn’t a clue what to do.

“We drank tea out of a pot at home. So I figured that you should open the bag and pour the tea into the water. And of course it floated on top and tasted terrible. And then I thought everybody in the place was looking at me strangely,” Dowling says.

“I think about that still. It’s why I’m sensitive to new immigrants who come here and do things that might look a little odd to us. They just don’t know better, like I didn’t, and need time to learn.”

Dowling moved around New York that first summer and lived in various places. He even had a room for a while across the Hudson River in Jersey City, though he didn’t at first know it.

“I thought I was in New York and only found out I was in the wrong state when someone asked me how I was getting home every night, and he said that I couldn’t be living in New York if I was taking a train for New Jersey,” he laughs.

Dowling thrived in his new surroundings and returned every summer during college, making use of the J-1 visa. He worked 100 hours a week, never took a day off, rarely socialized and saved lots of dollars, enough to pay for tuition, accommodation and many of his family’s expenses back in Knockaderry.

After he earned a bachelor’s degree from UCC in 1971, employment was scarce at home so Dowling returned to Manhattan. He intended to stay for a while, maybe a year or a little more, but like many Irish before and after him he remained for good.

If there was a job going, Dowling took it and learned it to perfection. Construction, plumbing, electrical work, even the engine room of the famed Circle Line tourist ship – no job was too big or small. He also made extra money cleaning high schools in the evening and Irish bars in Queens after last call. One of them, McLoughlin’s in Astoria, is still there.

Dowling kept in touch with his family back home by writing letters and making occasional, hard-to-arrange phone calls, which were expensive at that time. Letters would typically take two weeks to send back and forth. His would contain a date and time for his parents and siblings to wait at the telephone kiosk in front of the church in Knockaderry for a phone call from New York. Half the time the connection wouldn’t even work.

“And then you’d have the lady who plugged the call through listening in on the line for the gossip,” he laughs. “My mother of course couldn’t take the call because she wouldn’t be able to hear me. But I could hear her in the background saying, ‘Is he all right? Is he eating enough?’”

Dowling was earning good money and enjoyed all the work, but he wanted more. “I wasn’t quite sure at the time, but I knew I was on a ladder on rung two, and I wanted to get to rung five,” he says. “I didn’t know what five was, but it was better than two.”

After earning his undergraduate degree from UCC, Dowling returned to college, this time at Fordham University at Lincoln Center where he studied for a master’s degree in social work. The profession he first thought he’d be confined to when he enrolled in UCC, teaching, actually proved to be a perfect fit for Dowling at Fordham, where he began as an adjunct professor after earning his master’s degree in 1974. One course soon led to a full slate, and not long after, in 1978, Dowling became the assistant dean of Fordham’s Graduate School of Social Service, and director of the school’s Tarrytown campus in 1980.

Not surprisingly, he chose to continue his education and studied for a doctorate at Columbia University. He took courses in economics and public welfare, passed all exams and received approval for his dissertation which would have taken two to three months to complete.

But it didn’t happen. An unexpected phone call intervened, and it was a game changer. It also boosted Dowling up another rung on the ladder, and gifted him with one of the best friends and mentors he ever had.

DURING his time at Fordham, Dowling had been involved in public policy and wrote articles -- nothing major or groundbreaking, he says -- on various related issues.

Someone from the newly inaugurated administration of New York Governor Mario Cuomo took notice. Dowling received an offer in 1983 to join Cuomo’s team in Albany, and at first he declined. He was happy in Fordham, married to his Irish American wife Kathleen, and also was teaching classes at the New School at night.

Michael Dowling and his wife Kathleen.

Michael Dowling and his wife Kathleen.

But the Cuomo people were persistent, and Dowling eventually accepted. He figured he would take a year off from Fordham, see what life in the state capital was like, and then return to academia.

Dowling’s plan wound up in the same bin as his original intention to return home to Ireland. He immersed himself in state health issues and became deputy commissioner of the New York State Department of Social Services, commuting between Albany and his home in Westchester for four and a half years.

The move to the capital became permanent when Dowling got the call in 1988 from Cuomo’s office to work for the governor directly as deputy secretary for human services. The two had met in passing at various public events and unveilings. Dowling’s Department of Social Services had won an innovation award from Harvard University for a new welfare program which was a national example at the time; his team also received other recognitions for its work on long-term care.

“I would meet the governor at these things and we would talk for a while, but it was nothing too extensive,” Dowling says. “I found later he was impressed with our work and I was in the newspaper quite a bit.

“The first time I actually sat and talked to him at any length was when he called me up to his office, and I’ll never forget what he said. ‘When can you start?’ he asked me. I said, ‘Start what?’ And he said, ‘Here. You’re going to be here in my office.’ So that’s what I did.

“We became very close, very friendly. We worked with each other every day and I got to know him extremely well.”

Dowling became the governor’s director of health, education and human services in 1991. With genuine affection, he describes Cuomo as a “phenomenal person, a great person. I can’t say enough about him. I was able to be very frank and upfront with him and he appreciated that.”

Dowling credits Cuomo with believing in his abilities, “even though he had no assurances that I could do any of the things that he gave me to do. He just threw me into the middle of it. In many ways I am where I am today because of the opportunity that he gave me.”

Dowling and the governor were so tight that the Cuomo family – the governor’s wife Matilda, son Andrew, who followed in his father’s footsteps as governor, and the other Cuomo children, Maria, Margaret, Madeline and Chris -- became almost like his own. The deep bond continues to this day.

One of Mario Cuomo’s favorite gifts was a Donegal tweed cap from Dowling that he wore often. And Dowling will forever treasure the memory of Cuomo giving a keynote speech in his honor at the Irish America magazine Business 100 luncheon in November of 2013. A picture of them in fits of laughter at the party has pride of place in Dowling’s office.

“In all the years I knew him he never wanted to do that kind of thing,” he says. “I didn’t ask him to. And neither did the people at the magazine. He found out about it and he showed up.”

The governor was a tough as nails Italian, Dowling says, who loved many things: his family, New York State (he rarely spent a night outside of it), and basketball which he always played to win. And if he got hurt on the court, so be it.

Dowling chuckles when remembering the time when Matilda called him, urging an intervention when her husband wouldn’t seek treatment for what he called “a little cut” he got while playing. “He could be stubborn,” Dowling laughs. “No way did he want to be seen by a doctor, and Matilda was worried. She says to me, ‘You tell him he has to go. He’ll listen to you.’

“So I spoke to him. ‘Gov, you’ve got to go get stitched up. You gotta do it.’ And he went. Turns out he needed many stitches.”

Did Dowling ever shoot hoops with the boss? “Nope. He was rough! I never played with him. He wanted me to but I never did. He had a basketball team and he always won. He picked the best players.”

The liberal Democratic governor and his Irish right-hand man did great things together in Albany. By far the initiative that stands out the most was the creation of the Child Health Insurance Plan in 1990, now known as Child Health Plus, the state-subsidized insurance plan geared toward children whose families were ineligible for Medicaid. The state plan was a precursor to the federal Affordable Care Act, which was passed into law more than 20 years later.

“It’s still there and it’s vital,” Dowling says. “They were tough economic times, New York in the 1980s, and I think we protected the safety net for people.”

The governor’s three terms in Albany ended at the end of 1994. His deep friendship with Dowling endured until the day he died of heart failure on January 1, 2015. Dowling was one of the last people to see his old boss alive.

“I visited him in their apartment frequently,” he says. “The last time I saw him was the day before he passed. It was just Matilda and I there. His breathing was very labored. I knew it would be the final time I saw him.”

On March 16 of this year at the Plaza Hotel in Manhattan, Dowling will be honored by HELP USA, founded by Andrew Cuomo in 1986 to support homeless families. Dowling has received many awards during his illustrious career, but this one is extra special: it is named after his mentor, Governor Mario Cuomo, an unforgettable bedrock in Dowling’s life.

Michael Dowling and Government Cuomo.

Michael Dowling and Government Cuomo.

THE Dowlings contemplated a move to Europe after Cuomo left office in 1995. Dowling had several job offers – “I’ve been lucky in that, other when I first came to New York, I’ve never had to look for a job,” he says – including a position in Austria that he found intriguing.

During his time in the Cuomo administration, Dowling was asked to become part of a committee at the Institute of Human Sciences, an organization in Vienna that promotes advanced study in the humanities and social sciences, and intellectual exchange between different cultures. Founded in 1982, it is funded by the Austrian and Polish governments and other foundations, and is also involved in helping Eastern European countries transition from communism to democracy.

Dowling’s committee was tasked with deciding how to give money to organizations set up to help countries in transition. He liked the work and traveled to places like Warsaw, Budapest and Prague. The Institute asked if he would relocate permanently, and the Dowlings thought long and hard about it.

Ultimately they decided to stay in New York. Their two children, Brian and Elizabeth, were young and uprooting them would have been difficult.

“If I was single, or if we had no kids, I probably would have gone,” Dowling says. “The language barrier would have been a problem too. Everyone spoke multiple languages. I didn’t and my wife and kids didn’t either.”

Several other offers awaited, and the one he chose was a senior vice president position with Empire Blue Cross/Blue Shield based in both Albany and New York City. The insurance firm was generous with its offer and the work environment was top-class. But the fit wasn’t right.

“I didn’t like it at all,” Dowling said. “I sat looking at papers and spreadsheets and I wondered what everyone did. People sat around making medical decisions but they never saw the patient. It just wasn’t for me. I had to leave.”

He lasted at Empire less than a year, and when North Shore came calling in 1995 with a position as chief operating officer he jumped at the chance to join the expanding and ambitious hospital network based on Long Island, which was then generating annual revenue of about $1.5 billion.

“They were wild times, great times,” he recalls of North Shore’s growth spurt, which jumped into the super-charged lane after the 1997 merger with Long Island Jewish Hospital. Not even a lawsuit from the U.S. Justice Department and a trial that lasted two weeks could stop that union from happening.

The rest is history that continues to be written, with Dowling and Northwell leading the way.

“Bringing hospitals together that didn’t want to come together wasn’t easy. Everyone understood they should do it, but no one wanted to be the first,” he says.

The movement to cut costs, upgrade care and enhance bargaining power with insurance companies through hospital consolidation was a new concept in New York when North Shore began its efforts, though it was becoming standard practice in other states.

“When I was in Albany we had written papers about hospital duplication and the need to merge. When we created the governor’s Health Advisory Board I worked with Howard Gold who is here with us now (as executive vice president),” Dowling says.

“We produced a lot of documents that in essence were a blueprint for what we are doing now. Howard and I often talk about that.”

When Dowling joined North Shore in 1995, there were a number of hospitals under its umbrella. Now, with a new name, Northwell (unveiled at the start of 2016 to signal the network’s growing influence outside of Long Island and across the East Coast), there are 21 hospitals and counting. The hospitals under the Northwell brand have become infinitely better in every way after making the move.

In 2002, Dowling became president and CEO of the North Shore-LIJ Health System. His philosophy is to retain what is special about local cultures but blend and integrate them into a system culture.

Dowling behind his desk at Northwell.

Dowling behind his desk at Northwell.

“Northwell has central administration and central leadership and most of our functions are consolidated: purchasing, finance, quality control, technology, all of those things,” Dowling says.

“Of course if something is locally unique to a location you don’t want to kill it, but our hospitals don’t operate on their own. They are part of the whole network.”

The spreadsheets and document reading are naturally a part of Dowling’s job. He never uses a computer and reads emails printed for him by his executive assistant, who responds on his behalf based on Dowling’s handwritten notes on the email. His desk is filled with neat stacks of papers for his review and he spends his weekends reading through them, still working about 100 hours, seven days a week, just like when he first came to New York.

“Honestly, it’s not work to me,” says Dowling, a statement that’s especially true when he gets away from his desk and visits with hospitals and medical professionals on the front lines.

“I love getting out there, seeing what’s going on. You’ve got to get out and look at the underbelly of the organization. If you don’t know what’s happening on the ground, you won’t be able to make decisions,” he adds.

Dowling would never succeed on an episode of Undercover Boss; he’s way too visible to his 61,000-plus employees. He’d love to spend even more time in the ER or at a research lab, but there are only so many hours in a day, and Northwell’s growth is such that he has to juggle myriad responsibilities.

“It’s getting more difficult because the system is so big and there’s many other things you have to be doing. I don’t get five minutes around here,” he says of his office. “I come in and have a meeting, and then I think I can go off to a hospital. And then of course something else happens. It’s a big place.”

Under Dowling’s leadership, Northwell is positioned to grow even larger in the months and years ahead. Of that he is certain.

“We’ll be in New Jersey, and we’re in talks with places in Philadelphia, and we’ll expand in upstate New York, and Connecticut as well. We have lots of relationships working and lots of unique opportunities,” he says.

“If we are going to join forces with a new hospital, it has to be the right fit. You have to make sure they want to do the right thing. There’s no point in aligning if people are going to be stuck in their old ways.”

Health care is an ever-evolving industry, and Dowling is always contemplating the future. What’s going to be happening five years from now? What will consumers expect?

“Times change and trends change and I spend a lot of time thinking about what we should look like in the years ahead,” he says. “What’s the next move? How do you position yourself before you’re disrupted by something else? We have to continue to evolve and get better all the time.”

Other health care systems throughout the country have taken notice of Northwell’s impressive growth and results. It’s not unusual for leaders of major hospitals to visit Dowling to seek his advice on how to best consolidate and grow.

“We’ve done it better than most, and we’re very proud of that,” he says.

DOWLING’S mother and father didn’t live to see all of his successes, but both of them did make it to America.

Jack Dowling came to New York once in the 1980s. Michael was living in Queens at the time. His father was awed by what he saw, but his sense of distance was off.

One day he put on his cap and coat and declared he was going for a walk. His destination? The gravesite of President John F. Kennedy. Jack Dowling didn’t realize that Arlington National Cemetery in Virginia was hundreds of miles away.

“In Ireland everything was walking distance. He had no concept of the scale here. He thought he could walk up the road and see Kennedy’s grave,” said Dowling. They made the trip to Arlington together, and Jack was thrilled because of the Kennedy legend in Ireland.

Jack Dowling didn’t push his eldest child to pursue an education, but he was proud of his academic achievements and was even given to boasting. Dowling recalls one amusing memory of his father telling all the locals in Knockaderry that his son was studying to be a doctor.

“It was when I was in Columbia going for my doctorate,” he says. “He would tell everybody his son was a doctor as if I was a medical doctor. I would say, ‘Dad, I’m not a medical doctor, don’t tell everyone I can fix their problems!”

Meg Dowling loved New York and would visit her son every summer after Jack died. Sometimes she’d stay for a month and had a great time, but there was no place like home. She’d always look forward to returning to Limerick, to family and friends, and bingo and cards.

“It was easier for her in Ireland too because everybody knew about her deafness and could understand her there. Here it was more difficult,” Dowling says.

Through a mutual friend, Dowling met his wife Kathleen Butler. She was the daughter of a salesman who traveled extensively, and the family eventually settled in New Jersey. Her mother was German and her father was Irish American, “more Irish than the Irish themselves,” Dowling says.

“You know you hear about those families here. They constantly have the Irish music going and they’re all into Irish traditions. That was Kathy’s family.”

Kathy Dowling comes from a health care background herself. She was a top student at the University of Connecticut, won a full scholarship to Harvard Business School and left because she didn’t like it, and earned academic honors at the New School. She used to be employed as the head of labor relations and personnel for Beth Israel Hospital in Manhattan.

“Kathy understands the workload I have and the long hours. She’s very understanding and there’s never any grief,” Dowling says.

The Dowlings have two grown kids. Brian, 35, is an administrator within Northwell’s Imaging Service Line and lives not far from his parents. Elizabeth, 27, works as an oncology nurse at the same center and resides in Manhattan.

The family would occasionally travel to Ireland when the kids were growing up. Elizabeth loves it there and regularly visits friends in Dublin. “My daughter is into everything Irish,” Dowling says. “She loved Irish dancing and Michael Flatley and she really likes her trips there.”

The job of running such a vast health care system is a massive, all-encompassing responsibility, one that Dowling never really switches off from. How does he unwind? Having idle time on his hands is not something he enjoys.

“Well, if I do anything that’s not work related, it’s going to the theater with my wife, or once a week we try to go to dinner,” he says. “I don’t golf, and I don’t hang out with a bunch of guys. I like to be home, but sitting around and having nothing to do would drive me crazy.

“I have a nice comfortable chair and I’ll sit there and read my books, or do my paperwork. I compile lists of books that I’ve enjoyed to share with the staff. I belong to a number of national organizations and I’m on the board of a lot of entities, so that takes up my time too.”

Dowling sleeps only four to five hours a night, and is in meetings by 6:30 in the morning. His work day typically doesn’t end until after eight or nine in the evening. He spends about 16 hours each weekend going through documents, and hands a stack of paperwork to his assistant every Monday morning. Clutter will never have a place in his world.

“I can’t stand stuff around the place. It’s got to be taken care of. My desk is not full of stuff,” he says.

“I do everything by hand. Everything gets printed. I read it, and if I have to write something I do it in longhand. If I write it like that I absorb the information much better.”

Injuries and medical issues have also played a part in Dowling’s life. He’s had back problems that likely stem from years of playing sports in Ireland and early days of hard labor in New York. About a decade ago, he had stents implanted in his heart. In 2013 Dowling had five surgeries – “that was not a good year,” he says – two on his back, one on his shoulder and two for meniscus tears in his knees.

One thing is for certain: the injuries won’t keep Dowling from marching up Fifth Avenue as grand marshal on St. Patrick’s Day. It’s one of the highest honors an Irish person can achieve, leading the tribe in the world’s most-famous parade.

His four siblings, their spouses and many of their kids will make the journey from Ireland to mark the occasion. All of them built their adult lives in Ireland; Dowling’s sister lives in an expanded and upgraded version of the family home in Knockaderry.

“Everyone is very excited, and so am I,” he says. “It’s going to be good. I’ll always be extremely proud of being Irish.”

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